Sarcoid Uveitis

One of the most common systemic causes of uveitis is sarcoidosis.

What is Sarcoidosis?

The color photo shows the iris of a patient with Sarcoid Uveitis. There is an iris nodule and also an area where the inflammation caused the iris to stick to the lens. Sarcoidosis, also called sarcoid, is a disease involving abnormal collections of inflammatory cells (granulomas) that can form as nodules in multiple organs. The granulomas are most often located in the lungs or its associated lymph nodes, but any organ can be affected. Sarcoidosis seems to be caused by an immune reaction to an infection or some other trigger. Eye involvement occurs in about 10–90% of cases. Manifestations in the eye include uveitis, uveoparotitis, and retinal inflammation, which may result in loss of visual acuity or blindness. The most common ophthalmologic manifestation of sarcoidosis is uveitis.

What are Symptoms of Sarcoid Uveitis?

This photo shows macular edema which causes vision loss and sometimes distortion of vision. People with ocular sarcoidosis will sometimes have a red painful eye. They can be light sensitive. If there is inflammation in the back of the eye patients will sometimes see floaters. In addition, if there is severe inflammation of the retinal vessels or the retina itself, then severe vision loss can occur. Thankfully severe vision loss is uncommon in patients with ocular sarcoid.

How is sarcoid Diagnosed?

History of lung or breathing problems, enlarged lymphn nodes and a rash in a patient with uveitis can be suggestive of Sarcoid. In addtion, there are certain findings that are more common in patients with sarcoid, like iris nodules, inflammation around the retinal veins and the chorioretinal infiltrates seen in the photo below. Blood tests can be helpful, like an ACE and serum lysozyme. In addition, chest imaging with x-ray or computed tomography scan is helpful looking for specific lung lesions (hilar lymphadenopathy). The diagnosis is only certain with a tissue biopsy, usually a lung biospy or lymph node biopsy showing typical findings of sarcoid.

How is sarcoid treated?

Treatment depends on the severity of the disease and about the extent of systemic disease. If there is systemic sarcoid then treatment systemically with oral corticosteroids, methotrexate or biological agents like remicade can usually control the ocular disease. Because of the side effects of systemic therapy, if only the eye is involved, then ocular therapy can be effective. These scans show an excellent response to drops in this patient with sarcoid uveitis and macular edema. If the drops didn't work, periocular or intraocular steroids are usually effective.

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